Substitute House Bill No. 5561 aims to enhance Medicaid services and reimbursement rates for various healthcare providers in Connecticut, with a focus on cognitive assessments, dental services, and home health care. Effective July 1, 2026, the bill requires the Commissioner of Social Services to amend the Medicaid state plan to include Medicare billing codes for cognitive assessments for patients aged 64 or younger showing signs of cognitive impairment. It also establishes a cap of $1,000 per calendar year for adult nonemergency dental services while exempting certain preventive and medically necessary services from this cap. Additionally, the bill mandates that safety net pediatric dental clinics receive Medicaid reimbursement rates comparable to federally qualified health centers. Other provisions include a 10% annual increase in fees for home health services over six years and adjustments to reimbursement rates for various providers, including optometrists, doulas, and psychologists.

The bill also modifies the composition of the council overseeing Medicaid services by removing the requirement for a representative from an administrative services organization and adding two representatives from the Connecticut Dental Health Partnership. It requires the Commissioner of Social Services to report on prior authorization requirements for biomarker testing by October 1, 2026, and includes provisions for nonprofit organizations to reinvest savings from contracts with the Department of Developmental Services into services provided under contracts with the Department of Social Services. Overall, the bill seeks to improve access to essential health services for vulnerable populations while ensuring appropriate oversight and reimbursement for providers, with specific amendments to existing laws and the introduction of new provisions to enhance healthcare delivery in the state.

Statutes affected:
Raised Bill: 4-220
HS Joint Favorable Substitute: 4-220
File No. 445: 4-220